新疆维吾尔自治区南疆地区肺结核患者治疗相关心理负担影响因素及其作用路径分析

doi:10.19982/j.issn.1000-6621.20250454

摘要/Abstract

摘要：

目的: 探讨新疆维吾尔自治区南疆地区肺结核患者治疗相关心理负担的影响因素及其作用路径。方法: 2024年1月至2025年7月期间,采用分层整群随机抽样方法,抽取南疆4个地州8个县区中在“结核病信息管理系统”登记并完成治疗的1483例肺结核患者进行问卷调查;构建多水平模型和结构方程模型探索治疗相关心理负担的影响因素及作用路径,同时验证患者服药依从性的中介效应。结果: 1483例患者中,高心理负担者470例(31.7%),低心理负担者1013例(68.3%)。多水平模型显示,文化程度初中及以下(OR=1.675,95%CI:1.293~2.169)、疾病认知较差(OR=2.340,95%CI: 1.733~3.159)、服药依从性较差(OR=2.370,95%CI: 1.639~3.426)、家庭功能障碍(OR=1.695,95%CI: 1.157~3.003)、家庭支持不足(OR=2.329,95%CI: 1.771~3.062)及对治疗不满意(OR=3.109,95%CI: 2.229~4.336)均是心理负担的独立危险因素。结构方程模型结果显示,家庭功能(β=0.120)与满意度(β=0.367)均对心理负担具有直接正向效应,家庭支持呈现直接负向效应(β=-0.097);服药依从性在家庭支持与家庭功能对心理负担的影响中起完全中介作用,其直接效应分别为-0.096和0.117,间接效应分别为-0.001和0.003。结论: 南疆地区肺结核患者治疗相关心理负担受文化程度、疾病认知、家庭功能、家庭支持、治疗满意度及服药依从性等多种因素影响;家庭功能和家庭支持可完全通过服药依从性间接影响心理负担。

关键词: 结核,肺, 心理过程, 模型, 结构, 因素分析,统计学

Abstract:

Objective: To investigate the factors influencing treatment-related psychological burden among tuberculosis patients in Southern Xinjiang Uygur Autonomous Region and their underlying pathways. Methods: From January 2024 to July 2025, a stratified clustered random sampling method was used to select 1483 patients with pulmonary tuberculosis who were registered in the Tuberculosis Information Management System and completed treatment in 8 counties/districts of 4 prefectures in southern Xinjiang for questionnaire survey. Multilevel model and structural equation model were constructed to explore the influencing factors of treatment-related psychological burden and their pathways, and to test the mediating effect of patients’ medication compliance. Results: A total of 1483 patients were included, with 470 (31.7%) exhibiting high psychological burden. Multilevel modeling revealed that lower educational attainment (OR=1.675, 95%CI:1.293-2.169), poor disease cognition (OR=2.340, 95%CI:1.733-3.159), poor medication adherence (OR=2.370, 95%CI:1.639-3.426), family dysfunction (OR=1.695, 95%CI:1.157-3.003), insufficient family support (OR=2.329, 95%CI:1.771-3.062), and dissatisfaction with treatment (OR=3.109, 95%CI:2.229-4.336) were independent risk factors for psychological burden. Structural equation modeling results indicated that family functioning (β=0.120) and satisfaction (β=0.367) exerted direct positive effects on psychological burden, while family support demonstrated a direct negative effect (β=-0.097). Medication adherence fully mediated the effects of family functioning and family support on psychological burden. Their direct effects were -0.096 and 0.117, respectively, while indirect effects were -0.001 and 0.003. Conclusion: The treatment-related psychological burden of patients with pulmonary tuberculosis in Southern Xinjiang is affected by many factors, such as education level, disease cognition, family function, family support, treatment satisfaction and medication compliance. Family function and family support indirectly affect psychological burden through medication compliance.

Key words: Tuberculosis, pulmonary, Mental processes, Models, structural, Factor analysis, statistical

中图分类号:

张雅莹, 王森路, 古丽孜巴·库尔班江, 阿卜力克木·艾力, 梁辰, 袁双龙, 李彩虹, 曹明芹. 新疆维吾尔自治区南疆地区肺结核患者治疗相关心理负担影响因素及其作用路径分析[J]. 中国防痨杂志, 2026, 48(6): 821-829. doi: 10.19982/j.issn.1000-6621.20250454

Zhang Yaying, Wang Senlu, Guliziba Kuerbanjiang, Abulikemu Aili, Liang Chen, Yuan Shuanglong, Li Caihong, Cao Mingqin. Analysis of influencing factors and pathways on psychological burden associated with pulmonary tuberculosis treatment in Southern Xinjiang Region of the Xinjiang Uygur Autonomous Region[J]. Chinese Journal of Antituberculosis, 2026, 48(6): 821-829. doi: 10.19982/j.issn.1000-6621.20250454

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参考文献 24

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模型	AIC	BIC	Entropy	LMRT	BLRT	类别比例
1	65000.89	65159.95	1.00	-	-	1
2	59141.10	59384.98	1.00	<0.001	<0.01	0.06/0.94
3	56764.67	57093.38	0.98	<0.001	<0.01	0.02/0.83/0.15
4	55246.35	55659.89	0.98	<0.001	<0.01	0.01/0.80/0.14/0.05
5	54547.10	55045.47	0.98	<0.001	<0.01	0.01/0.79/0.02/0.05/0.13
6	54579.12	55162.32	0.92	<0.001	1.00	0.01/0.76/0.02/0.05/0.03/0.13

变量	合计 (1483例)	高心理负担 [例(构成比,%)]	低心理负担 [例(构成比,%)]	χ²值	P值
性别				1.240	0.226
男性	713	216(30.3)	497(69.7)
女性	770	254(33.0)	516(67.0)
年龄组(岁)				2.236	0.327
≤45	288	89(30.9)	199(69.1)
46~64	570	164(28.8)	406(71.2)
≥65	625	211(33.8)	414(66.2)
文化程度				10.493	0.005
初中及以下	1303	394(30.2)	909(69.8)
高中及中专	116	49(42.2)	67(57.8)
大专及以上	64	27(42.2)	37(57.8)
人均月收入(元)				1.054	0.590
<1000	616	204(33.1)	412(66.9)
1000~	637	197(30.9)	440(69.1)
≥3000	230	69(30.0)	161(70.0)
婚姻状况				8.690	0.034
已婚	1009	301(29.8)	708(70.2)
未婚	101	42(41.6)	59(58.4)
离婚	59	16(27.1)	43(72.9)
丧偶	314	111(35.4)	203(64.6)
医保类型				1.650	0.199
城镇居民	1395	437(31.3)	958(68.7)
非城镇居民	88	33(37.5)	55(62.5)
疾病认知				108.504	<0.001
较好	1161	291(25.1)	870(74.9)
较差	322	179(55.6)	143(44.4)
服药依从性				85.178	<0.001
较好	1290	378(29.3)	912(70.7)
较差	193	92(47.7)	101(52.3)
家庭支持				74.159	<0.001
支持	707	147(20.8)	560(79.2)
不支持	776	323(41.6)	453(58.4)
满意度				106.078	<0.001
满意	1250	329(26.3)	921(73.7)
不满意	233	141(60.5)	92(39.5)
家庭功能				25.701	<0.001
良好	1414	429(30.3)	985(69.7)
障碍	69	41(59.4)	28(40.6)

参数	估计值	标准误	χ²值	P值
固定部分(截距)β₀	-0.967	0.275	-3.516	<0.001
水平2(县区)${\sigma }_{\mu 0}^{2}$	0.556	0.746	119.540	<0.001

变量	赋值情况
因变量
心理负担	较低=0;较高=1
自变量
文化程度	初中及以下=1;高中含中专=2;大专及以上=3
婚姻状况	已婚=1;未婚=2;离婚=3;丧偶=4
疾病认知	较好=0;较差=1
家庭功能	良好=0;障碍=1
家庭支持	支持=0;不支持=1
满意度	满意=0;不满意=1
服药依从性	较好=0;较差=1

参数	估计值		标准误	χ²值	P值	OR值	95%CI值
截距	-2.661		0.346	-7.685	<0.001	0.070	0.035~0.137
文化程度初中及以下	0.516		0.132	3.903	<0.001	1.675	1.293~2.169
疾病认知较差	0.85		0.153	5.544	<0.001	2.340	1.733~3.159
服药依从性较差	0.863		0.188	4.589	<0.001	2.370	1.639~3.426
家庭功能障碍	0.528		0.292	1.806	0.041	1.695	1.157~3.003
家庭不支持	0.845		0.14	6.052	<0.001	2.329	1.771~3.062
不满意	1.134		0.169	6.696	<0.001	3.109	2.229~4.336
随机效应参数	0.533		0.730	91.874	<0.001	-	-
组内相关系数(ICC)		0.145